HomeMy Public PortalAbout5218AGNES AVE_Building (3) ",� ,� APPLICATION F'OR�BI�ILDING PERMIT
FOR P CANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
BLOING
ADDRESS 5zq DEPARTMENT OF COUNTY ENGINEER
� ZIP q` (R
BUILDING AND SAFETY DIVISION
CITY
NO-OF BLDGS BUILDING fi
SIZE OF LOT 1 NOW ON LOT ADDRESS
TRACT ` r BLOCK LOT NO 8 LOCALITY
t TEL NEAREST
OWNER NO U11I CROSS ST
s ASSESSOR
ADDRESS Jttt MAP BOOK PAGE PARCEL
1 DISTRICT GROUP TYPE" FIRE PR ESSED BY
CITY � ZIP OL1 p O �/p p 1 CONST ZON/E/j
ARCHITECT OR TEL J O r�I
ENGINEER - NO STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS TEL
CLASS NO DWELL UNITS BK `t PG
CONTRACTOR NO USE ZONE MAP O j /
LIC n' 72� f®
ADDRESS NO ,{! SPECIAL
LIC CONDITIONS
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING
SO FT NO OF NO OF CHECK HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW + 0
CK FROM
Ir ADD ® BLDG SIDE PROP BLINEOFF (STREET) O
ALTER ❑ - TOTAL SETBACK FROM TYPE OF I EXISTING
USE OF REPAIR 1:3HIGHWAY + YARD = SIDE PROP LINE HIGHWAY WIDTH Z
EXISTING BLDG �%IbckC6 DEMOL El +
APPLICANTTEL o CORNER CUTOFF YES ❑ NO ❑
(PRINT) Q NO �9
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE(
Q IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$
x
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES i
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE v
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
PENSATION INSURAN"
SIGNATURE OF I
PERMITTEE
ADDRESS ISTIR
FINAL _ BY
TEL DATE
CITY 7 PA 011W-NO �
MAKE CHECKS PAYABLE TO FEE - FEET $
HARVEYT BRANDT COUNTY ENGINEER
PLAN CHECK VALIDATION CK- M O CASH - PERMIT VALIDATION CK M O CASH
6 5 L�JFEB 22 1 D
OS 76A638A CE#803 3 75
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